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Delirium after stroke linked to poorer outcomes for patients
Toronto, Ont., Canada (January 19, 2012) – Up to 30 per cent of patients hospitalized after a stroke develop delirium, according to a new study from St. Michael’s Hospital. Researchers found patients who experience delirium after stroke are five times more likely to die, and are more likely to be discharged to a long-term care facility, nursing home or have a longer stay in hospital.
"Early recognition and prevention of delirium are important for a quick recovery, better quality of life and timely discharge for patients who have suffered a stroke," said Dr. Gustavo Saposnik, lead author of the paper and director of the Stroke Outcomes Research Centre at the hospital.
Saposnik and colleagues analyzed 10 studies that looked at the four common outcomes in over 2.000 patients with delirium – inpatient and 12-month death rates, length of hospital stay and care arrangements after discharge.
Unlike dementia – a chronic, progressive mental disorientation – delirium is an acute, sudden state of confusion is often marked by lack of attention, disorientation, and sometimes hallucination.
Patients can become delirious at any time after a stroke, however when it occurs seven to 10 days later it is commonly related to a complication such as a respiratory or urinary infection, instead of as part of the stroke’s effects.
Recognizing the associated risk factors such as age, severity of stroke, infections, narcotic use, lack of oxygen and cognitive impairment can help clinicians identify initial signs of delirium and use early interventions.
The paper is published in Stroke: Journal of the American Heart Association.
Saposnik said this research aims to encourage early detection and intervention to improve outcomes for patients and families, but further research is needed to understand the most effective interventions.
St. Michael’s Hospital has developed the Delirium Prevention Program (DPP) to reduce the occurrence of delirium – especially in elderly patients – and to improve patients’ experience.
The DPP is a multi-disciplinary team approach that uses simple strategies in everyday care to help keep patients oriented. Clocks have been installed in every patient’s room along with whiteboards, on which the date is written daily; Lights on the orthopedic unit and overhead paging systems are turned off at night to minimize confusion over time of day; and blinds are opened daily so patients have natural light rhythms.
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The Hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing Knowledge Institute, research at St. Michael’s Hospital is recognized and put into practice around the world. Founded in 1892, the Hospital is fully affiliated with the University of Toronto.
St. Michael’s Hospital, 19.01.2012 (tB).